Preventing deep vein thrombosis in hospital inpatients
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39247.542477.AE (Published 19 July 2007) Cite this as: BMJ 2007;335:147
- William E Cayley Jr, associate professor
- Augusta Rural Training Site, Eau Claire Family Medicine Residency, University of Wisconsin Department of Family Medicine, 207 West Lincoln, Augusta, WI 54701, USA
- bcayley{at}yahoo.com
- Accepted 13 June 2007
Summary points
• Appropriate use of prophylaxis against deep vein thrombosis (DVT) in hospital inpatients is important for reducing the risk of fatal and non-fatal pulmonary embolism and post-thrombotic complications
• For patients at low risk of DVT, ambulation is important, and mechanical methods of prophylaxis (such as graduated compression stockings and intermittent pneumatic compression devices) can provide added protection
• Patients at higher risk of DVT should be considered for guideline based anticoagulation with low molecular weight heparin, unfractionated heparin, or vitamin K antagonists unless clearly contraindicated
• Fondaparinux may provide additional prophylactic options
• The place of aspirin in DVT prophylaxis remains controversial
• To ensure adequate prophylaxis against DVT, doctors should be encouraged to follow appropriate guidelines
Most hospital inpatients are at risk of deep vein thrombosis (DVT) and the associated complications of fatal or non-fatal pulmonary embolism and post-thrombotic syndrome. Recognised risk factors for DVT are generally related to one or more elements of Virchow's triad (stasis, vessel injury, and hypercoagulability), and include surgery, trauma, immobilisation, malignancy, use of oestrogens, heart or respiratory failure, and smoking (box 1).1 Surveillance studies have found that the absolute risk of DVT is 10%-20% among general medical patients and up to 40%-80% in patients having hip surgery, knee surgery, or major trauma (table⇓).1
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Absolute risk of deep vein thrombosis in hospital inpatients
Box 1 Risk factors for deep vein thrombosis (adapted from Geerts et al1)
Stasis
• Surgery, trauma, immobility, paresis
• Increasing age
• Pregnancy and postpartum
• Heart or respiratory failure
• Obesity
Vessel injury
• Previous deep vein thrombosis
• Smoking
• Varicose veins
• Central venous catheterisation
Hypercoagulability
• Increasing age
• Malignancy or cancer therapy
• Oestrogen therapy (contraception or hormone replacement)
• Acute medical illness
• Inflammatory bowel disease
• Nephrotic syndrome
• Myeloproliferative disorders
• Paroxysmal nocturnal haemoglobinuria
• Inherited or acquired thrombophilia
It is difficult to predict …
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